This career development award seeks to provide the advanced knowledge, skills, and experience for the candidate's career transition to an independent physician-investigator researcher. His long-term goal is to use mixed methods to measure and improve patient/family-centered outcomes for critically and chronically ill children, especially around difficult or divisive decisions. With a background in pediatric critical care medicine, ethics, and quantitative clinical research, the candidate has begun to develop the knowledge-base and skills necessary for this goal. This award proposal details a 4-year scope of research through which he will gain the foundation for future research endeavors. Specifically, the goals of this proposal are to: 1) conduct a novel research project under the mentorship of an interdisciplinary team of expert researchers; 2) acquire expertise in qualitative, translational, and other methodologies through firsthand experience, didactic interactions with mentors, and graduate level coursework; 3) build a network of colleagues and collaborators within Columbia University and elsewhere through this research and participation at national meetings; and 4) prepare and submit a federal research grant with a translational focus, based upon the skills and findings from this award period. The specific research project through which he will accomplish these goals addresses the unmet need for decision support around whether or not to initiate children with chronic respiratory failure and other life- limiting conditions on chronic ventilation. The specific aims are: 1) Determine the decision quality and needs of families facing whether to initiate their child on chronic ventilation; 2) Assess financial burdens relevant for family decision making around chronic ventilation; and 3) Develop and pilot test information and decision support tools for families deciding whether to initiate their child on chronic ventilation.